Provider Demographics
NPI:1053146407
Name:VISTA DEL MAR CHILD AND FAMILY SERVICES
Entity type:Organization
Organization Name:VISTA DEL MAR CHILD AND FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QUALITY, STANDARDS AND COM
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-836-1223
Mailing Address - Street 1:6926 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3306
Mailing Address - Country:US
Mailing Address - Phone:323-934-7979
Mailing Address - Fax:323-934-0514
Practice Address - Street 1:6926 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3306
Practice Address - Country:US
Practice Address - Phone:323-934-7979
Practice Address - Fax:323-934-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty